Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Initial assessments for a patient presenting with urinary incontinence should include:
- History taking: Categorise the type of urinary incontinence (stress, urgency/overactive bladder, or mixed) based on symptoms and identify predisposing or precipitating factors and other diagnoses that may require referral or further investigation NICE NG123.
- Physical examination: Perform a general physical exam including abdominal and external genitalia examination; consider vaginal or rectal examination if clinically indicated (e.g., to assess pelvic floor prolapse or anal tone) NICE NG123,NICE CG148,NICE NG210.
- Pelvic floor muscle assessment: Undertake a digital assessment to confirm pelvic floor muscle contraction before starting supervised pelvic floor muscle training NICE NG123.
- Urine testing: Perform a urine dipstick test to detect blood, glucose, protein, leucocytes, and nitrites. If infection is suspected, send a midstream urine sample for culture and sensitivity and start antibiotics if appropriate NICE NG123,NICE CG148.
- Post-void residual volume measurement: Measure residual urine volume by bladder scan (preferred) or catheterisation if symptoms suggest voiding dysfunction or recurrent urinary tract infections NICE NG123.
- Symptom and quality-of-life assessment: Use validated urinary incontinence-specific symptom and quality-of-life questionnaires to evaluate the impact and guide treatment NICE NG123.
- Bladder diary: Encourage the patient to complete a bladder diary for at least 3 days to document urinary frequency, urgency, leakage episodes, fluid intake, and pad usage NICE NG123,NICE CKS,NICE CKS.
- Medication review and assessment of contributing factors: Review medications and consider other causes such as neurological disease, diabetes, pelvic masses, or mobility and cognitive impairments NICE NG123,NICE NG210.
Additional notes: Do not routinely perform pad tests, cystoscopy, or imaging (other than bladder scan for residual urine) in the initial assessment NICE NG123. Refer to specialist services if there are complex features such as persistent bladder pain, palpable bladder after voiding, neurological disease, or previous pelvic surgery NICE NG123.